Is thermochemotherapy with the Synergo system a viable treatment option in patients with recurrent non‐muscle‐invasive bladder cancer?. (22nd October 2014)

• Record Type: Journal Article
• Authors: Kiss, Bernhard; Schneider, Silvia; Thalmann, George N; Roth, Beat
• Is Part Of: International journal of urology. Volume 22:Number 2(2015)
• Page Start: 158
• Page End: 162
• Publication Date: 2014-10-22
• Subjects: Urology -- Periodicals; Genitourinary organs -- Periodicals; Urologic Diseases -- Periodicals; 616.6005
• DOI: 10.1111/iju.12639
• Languages: English
• ISSNs: 0919-8172

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="iju12639-sec-0001" sec-type="section"> <title>Objectives</title> <p>To prospectively evaluate the outcome of combined microwave‐induced bladder wall hyperthermia and intravesical mitomycin C instillation (thermochemotherapy) in patients with recurrent non‐muscle‐invasive bladder cancer.</p> </sec> <sec id="iju12639-sec-0002" sec-type="section"> <title>Methods</title> <p>Between 2003 and 2009, 21 patients (median age 70 years, range 35–95 years) with recurrent non‐muscle‐invasive bladder cancer (pTaG1‐2 <italic>n</italic> = 9; pTaG3 <italic>n</italic> = 3; pT1 <italic>n</italic> = 9; concurrent pTis <italic>n</italic> = 8) were prospectively enrolled. Of 21 patients, 15 (71%) had received previous intravesical instillations with bacillus Calmette–Guérin, mitomycin C and/or farmorubicin. Thermochemotherapy using the Synergo system was carried out in 11 of 21 patients (52%) with curative intent, and in 10 of 21 patients (48%) as prophylaxis against recurrence.</p> </sec> <sec id="iju12639-sec-0003" sec-type="section"> <title>Results</title> <p>The median number of thermochemotherapy cycles per patient was six (range 1–12). Adverse effects were frequent and severe: urinary urgency/frequency in 11 of 21 patients (52%), pain in eight of 21 patients (38%) and gross hematuria in five of 21 patients (24%). In eight of 21 patients (38%), thermochemotherapy had to be abandoned because of the severity of the adverse effects (pain in 3/8, severe bladder spasms in 2/8, allergic reaction in 2/8, urethral perforation in 1/8). Overall, six of 21 patients (29%) remained free of tumor after a median follow up of 50 months (range 1–120), six of 21 patients (29%) had to undergo cystectomy because of multifocal recurrences or cancer progression and seven of 21 patients (33%) died (2/7 of metastatic disease, 5/7 of non‐cancer related causes).</p> </sec> <sec id="iju12639-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Given the high rate of severe side‐effects leading to treatment discontinuation, as well as the limited tumor response, thermochemotherapy should be offered only in highly selected cases of recurrent non‐muscle‐invasive bladder cancer.</p> </sec> </abstract>